Dental enamel: detection of surface changes by ultrasound.

Evidence indicates that the tooth surface differs in structure from the enamel immediately beneath it, and particularly that the enamel rod type structure is minimal in the true natural surface. Furthermore, the rod ends appear to disappear with age after the eruption of the tooth. The thickness of the surface layer may be as much as 25 micrometers. Studies of caries incidence show a peak in the attack curve 2 to 4 years after eruption and a decline thereafter for all teeth. This information indicates that the mechanical structure of the tooth surface should be carefully studied. A highly useful means appears to be ultrasound since the specific acoustic impedance of highly mineralized tissue like enamel is strongly dependent on fraction volume mineralization and since non-destructive test techniques can be based on ultrasonics. An experimental demonstration of ultrasonic detection in vitro of tooth surface demineralization is given.

Factors predictive of tumor growth, tumor decalcification, choroidal neovascularization, and visual outcome in 74 eyes with choroidal osteoma.

OBJECTIVE: To evaluate choroidal osteoma for tumor growth, tumor decalcification, related choroidal neovascularization, visual acuity loss, and poor visual acuity. DESIGN: Retrospective nonrandomized single-center case series. SETTING: Ocular Oncology Service at Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pa. PARTICIPANTS: There were 74 eyes of 61 patients with choroidal osteoma evaluated between January 1, 1977, and January 1, 2003. MAIN OUTCOME MEASURES: The 5 outcome measures included tumor growth, tumor decalcification, related choroidal neovascularization, visual acuity loss of 3 or more Snellen lines, and poor visual acuity of 20/200 or worse. RESULTS: At 5 and 10 years, Kaplan-Meier analysis revealed tumor growth in 22% and 51% of eyes, tumor decalcification in 28% and 46% of eyes, choroidal neovascularization in 31% and 31% of eyes, visual acuity loss in 26% and 45% of eyes, and poor visual acuity in 45% and 56% of eyes, respectively. The clinical factor predictive of tumor growth was absent overlying retinal pigment epithelial alterations. The factor predictive of decalcification was irregular tumor surface. Of the 15 tumors that showed partial decalcification at the first visit, there was no further tumor growth in any case. Of the remaining 12 tumors that later developed decalcification, tumor growth, if it occurred, was along the margin opposite the decalcification. No tumor showed growth in the region of decalcification. Factors predictive of choroidal neovascularization included irregular tumor surface and subretinal hemorrhage. In 6 eyes that had both choroidal neovascularization and tumor decalcification, the neovascularization was detected prior to or at the same time as the decalcification. The factor predictive of visual acuity loss was presence of subretinal fluid whereas the factors predictive of poor visual acuity included symptoms and tumor decalcification. A comparison of eyes with subfoveal vs extrafoveal choroidal osteoma showed poor visual acuity in 15 (34%) of 44 eyes and 3 (10%) of 30 eyes, respectively. Eyes with decalcified choroidal osteomas manifested poor visual acuity in 13 (48%) of 27 eyes whereas those with nondecalcified tumors showed poor visual acuity in 5 (11%) of 47 eyes. CONCLUSIONS: Choroidal osteoma showed evidence of growth in 51% of eyes and decalcification in nearly 50% of eyes by 10 years. Tumors with any degree of decalcification at the initial visit showed no further growth. Overall, poor visual acuity of 20/200 or worse was found in 56% of eyes by 10 years, and decalcified subfoveal choroidal osteomas displayed a particularly poor visual prognosis.

Orbit deformities in craniofacial neurofibromatosis type 1.

BACKGROUND AND PURPOSE: The possible relationship of orbit deformities in neurofibromatosis type 1 (NF1) to plexiform neurofibromas (PNFs) have not been fully elucidated. Our purpose was to review orbital changes in patients with craniofacial NF1. METHODS: We retrospectively reviewed CT and MR imaging abnormalities of the orbit in 31 patients (18 male, 13 female; mean age, 14 years; age range 1-40 years) with craniofacial NF1. RESULTS: Orbital abnormalities were documented in 24 patients. Six had optic nerve gliomas with enlarged optic canals. Twenty had PNFs in the orbit or contiguous to the anterior skull. The posterior orbit was distorted by encroachment from an expanded middle cranial fossa in 13 patients, and 18 had enlargement of the orbital rim. Other changes included focal decalcification or remodeling of orbital walls adjacent to PNFs in 18 patients and enlargement of cranial foramina resulting from tumor infiltration of sensory nerves in 16. These orbital deformities were sometimes progressive and always associated with orbital infiltration by PNFs. CONCLUSION: In our patients with craniofacial neurofibromatosis, bony orbital deformity occurred frequently and always with an optic nerve glioma or orbital PNF. PNFs were associated with orbital-bone changes in four patterns: expansion of the middle cranial fossa into the posterior orbit, enlargement of the orbital rim, bone erosion and decalcification by contiguous tumor, and enlargement of the cranial foramina. Orbital changes support the concept of secondary dysplasia, in which interaction of PNFs with the developing skull is a major component of the multifaceted craniofacial changes possible with NF1.

[Developmental osteopenia: decrease of bone mineral density or systemic impairment?]. / Osteopenia w wieku rozwojowym--obnizenie mineralizacji koscca czy zaburzenie ogólnoustrojowe?

In the quantitative evaluation of bone osteopenia is defined as a decrease of mineral density by more than 1 SD from the established normal values (age, sex, peak bone mass...). The border of osteopenia and osteoporosis is demarcated by -2.5 SD (T-score) in adults, while in children the most proper is considered to be -2.0 SD (Z-Score). The aim of the study was to determine whether developmental osteopenia is accompanied by biochemical abnormalities and what are clinical symptoms concomitant with this condition. The studies include 28 children aged 5-17 years, in whom no chronic disease, especially of locomotor system, was found. The basis for diagnosis was densitometric examination of bone, with DEXA method (densitometer by Lunar), vertebral column (Spine) in the pediatric program or for adults. The most frequent causes for referring to the examination were pain in the spine, limbs or history of multiple bone fractures. In the performed biochemical examinations hypomagnesemia, decreased concentration of 25OHD and PTH in blood serum, increased activity of bone isoenzyme of alkaline phosphatase as well as increased excretion of hydroxyproline in urine, were found in several children. In about 1/3 of the children low body mass, and in some cases also retardation of the bone age was revealed. The results of our studies allow a conclusion, that in children with certain clinical abnormalities from locomotor system osteopenia may take place. This disturbance is concomitant with various deviations in calcium-phosphate metabolism and requires adequate therapy. It may be supposed, that in the majority of children, osteopenia was caused by low dietary calcium intake, together with reduced physical activity and vitamin D deficiency. The observations and conclusions from the study are of important practical significance, because children with osteopenia are the risk group for the appearance of osteoporosis in their future life.

[Prevalence of bone decalcification in the treatment of Crohn's disease]. / Prevalence odvápnení kostí pri lécbe Crohnovy nemoci.

In clinically active Crohn's disease the bone mineralization is impaired due to calcium malabsorption by the inflamed intestinal wall which is potentiated by diarrhoea and the thus accelerated transit time. To this we must add the shortening of the gut after operations, the inadequate dietary calcium supply or possibly calcium elimination in case of concurrent lactose intolerance. Corticoid treatment leads also to deterioration of bone mineralization. This is the reason why the authors assessed in 98 patients with Crohn's disease the bone mineralization, using the method of clavicular bone index (NIBA). Then treatment was started: a high protein diet, calcium forte, Ossin (sodium fluoride), vitamin D forte, anabolics and regular physical exercise. Check-up examinations after one year revealed that the index was restored in the majority of patients (60.84%) to normal. The above treatment is thus effective. It must be, however, regular and of a long-term character, in some patients it must extend over many years. We had, however, also patients who although subjected to an extensive resection of the gut and treated for prolonged periods with corticoids, had permanently an index between 100 and 120% without treatment.

[X-ray densitometry and biochemical parameters of bone tissue metabolism in patients with vibration disease]. / Rentgenodensitometricheskie i biokhimicheskie pokazateli metabolizma kostnoi tkani u bol'nykh vibratsionnoi bolezn'iu.

To reveal systemic and local osteoporosis, the authors studied biochemical markers of bone metabolism in vibration disease patients. The vibration disease patients appeared to have the most frequent and marked osteoporosis in peripheral bones--hands (in 90% of cases) and forearms (in 66.7%). Prevalence of systemic osteoporosis and osteopenia reached 11.7 and 48.3% in the select respectively. According to biochemical markers, bone reconstruction state was characterized by moderately intensified bone resorption and diminished bone formation.

Fiber Bragg grating sensor for monitoring bone decalcification.

INTRODUCTION: Estimation of decalcification is a vital tool to discern bone health. Different techniques are used for its quantitative measurement, e.g. DEXA, QCT & QUS. All these techniques, although noninvasive, suffer from limitations such as radiation exposure and inaccurate values. Recently, fiber optic techniques are fast emerging for medical applications owing to their various attractive features like immunity to EMI/RFI, geometric versatility, chemical inertness, etc. MATERIAL AND METHODS: The effect of decalcification on strain response of a goat tibia was investigated in vitro using fiber Bragg grating (FBG) sensing technique. The bone was strained by using three-point bending technique and corresponding Bragg wavelength shifts were recorded. Two similar bone samples from the same animal were taken and one was partially decalcified. Strain response of decalcified and untreated bone was taken concurrently to monitor the effects of calcium loss and that of degradation with time. RESULTS AND CONCLUSION: The strain generated for same stress increased with greater degree of decalcification and a steep increase occurred after 2g calcium loss, indicating the onset of damage. The strain response, therefore gives a direct indication of the degree of calcium present in the bone. LEVEL OF EVIDENCE: Level III.

Protocolo para el estudio de muestras y estandarización del informe patológico de tumores óseos / Protocol for the study of bone tumours and standardization of pathology reports

Las neoplasias primarias de hueso representan un grupo poco frecuente y heterogéneo de tumores mesenquimales con diferente prevalencia entre los benignos y los malignos o sarcomas (que suponen menos del 0,2% de todos los tumores malignos). Habitualmente se diagnostican y clasifican según los criterios establecidos y publicados por la Organización Mundial de la Salud (OMS 2013), en continua evolución como resultado de los avances en patología molecular y citogenética, que pueden complementar el diagnóstico. El diagnóstico y tratamiento de estos tumores debe realizarse en centros de referencia, con un abordaje multidisciplinar que incluya patólogos, radiólogos, cirujanos ortopédicos y oncólogos. Para elaborar esta revisión se han analizado diferentes protocolos nacionales e internacionales. Pretende servir como una guía de recomendaciones que ayuden a mejorar el manejo y la evaluación patológica de las neoplasias óseas en nuestro medio. Se describen las fases preanalítica, analítica y postanalítica y los protocolos macro y microscópico (AU)

Primary bone neoplasms represent a rare and heterogeneous group of mesenchymal tumours. The prevalence of benign and malignant tumours varies; the latter (sarcomas) account for less than 0.2% of all malignant tumours. Primary bone neoplasms are usually diagnosed and classified according to the criteria established and published by the World Health Organization (WHO 2013). These criteria are a result of advances in molecular pathology, which complements the histopathological diagnosis. Bone tumours should be diagnosed and treated in referral centers by a multidisciplinary team including pathologists, radiologists, orthopedic surgeons and oncologists. We analyzed different national and international protocols in order to provide a guide of recommendations for the improvement of pathological evaluation and management of bone tumours. We include specific recommendations for the pre-analytical, analytical, and post-analytical phases, as well as protocols for gross and microscopic pathology (AU)

Protocolo de estudio y estandarización del informe patológico de los tumores de partes blandas malignos y de comportamiento intermedio de adolescentes y adultos / Investigation protocol and standardization of pathology reports for soft tissue tumours with intermediate malignant potential in adolescents and adults

Los sarcomas de partes blandas son neoplasias poco frecuentes, que incluyen una amplia variedad de tipos histológicos, se presentan en cualquier localización y muestran una gran heterogeneidad, con solapamiento, en ocasiones, de la morfología de tumores con comportamiento clínico y biológico muy diverso. El diagnóstico es a menudo complejo, resultando necesarias guías que consensúen criterios que permitan homogeneizar la información, la terminología y la clasificación entre los diferentes centros. Basándonos en protocolos de otras sociedades científicas y en una revisión actualizada de la literatura, miembros del Club de Partes Blandas de la SEAP hemos elaborado este documento, en el que se revisan las diferentes fases del estudio de los sarcomas de partes blandas en los servicios de patología y se definen los datos fundamentales a incluir en los informes de estos tumores (AU)

Soft tissue sarcomas are infrequent neoplasms that include a wide variety of histological types. They may present in any location and show a great morphological heterogeneity; indeed, they may have similar characteristics to tumours with diverse clinical and biological behaviour, making their diagnosis difficult. Thus, guidelines are required in order to unify the information, terminology and classification from different diagnostic centres. Several members of the SEAP Soft Tissue Pathology Club have created a document based on protocols from other scientific societies and on an updated review of the literature. The protocol includes the different phases of the study of soft tissue sarcomas in the pathology department and aims to define the data that should be included in the final pathology reports (AU)